This form may be used to present an allegation that a cleric (bishop, priest, deacon) has committed an act of sexual abuse of a minor. The completed form is CONFIDENTIAL and is to be submitted via e-mail.

If there is an emergency, and you believe that a child is in imminent risk, please call 911, and then contact the New York State Hotline (1-800-342-3720). The Director of the Archdiocese Safe Environment Office can be contacted outside of business hours by email: emechmann@archny.org. You will be contacted within one business day.

To report a complaint of sexual abuse by a member of the clergy or anyone acting in the name of the Church, recently or in the past, please complete the form below and return it to the Archdiocese of New York. You may print the form and mail it to the Archdiocese, or you may send the form via email.

Online Form: Submit Complaint Online

After you submit the completed form, the Victim's Assistance Coordinator for the Archdiocese of New York will contact you within one business day.

I. INFORMATION AS TO THE COMPLAINANT

Full Name
Please enter valid data.

Address
Please enter valid data.

City
REQUIREDPlease fill out this field.Please enter valid data.

State
REQUIREDPlease fill out this field.

Zip
REQUIREDPlease fill out this field.Please enter a zip code.

Date of Birth
Please enter a date.

Name and Address of Parents/Guardian (if complainant is a minor)

Phone Number
Please enter a phone number.

Name of School (if complainant is a minor)
Please enter valid data.

II. INFORMATION AS TO ACCUSED

Name
Please enter valid data.

Parish/Place of employment
Please enter valid data.

Has the accused been confronted or informed of allegation?
REQUIREDNoYesPlease fill out this field.

If Yes, when and by whom?

III. INFORMATION AS TO ALLEGATIONS

Brief description of alleged abuse (time, place, and acts):

Have the allegations been reported to any civil authorities or Church personnel?
REQUIREDNoYesPlease fill out this field.

If Yes, when, how, and to whom?

Date of Report
Please enter a date.

PERSON REPORTING

Name
Please enter valid data.

City
Please enter valid data.

State

Zip
Please enter a zip code.

Phone Number
Please enter a phone number.

Email
Please enter an email address.

*All information submitted will be handled with the utmost discretion.

Total: $

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Other Methods to Submit a Complaint

U.S. Postal Service: Submit Complaint via U.S. Mail

If you select to mail your form via the US Postal Service please select one of the following printable versions: